The patient smoked 10 cigarettes a day, drank moderate quantities of alcohol and his medical history was unremarkable

The patient smoked 10 cigarettes a day, drank moderate quantities of alcohol and his medical history was unremarkable. in patients without clinical evidence of HIV-related pathology. BACKGROUND Kaposi sarcoma (KS) of the gastrointestinal (GI) tract was very rare before the AIDS epidemic. GI involvement can precede, be synchronous, or develop without the appearance of the skin lesions. Typically, GI KS is usually asymptomatic, but may present with gastric store obstruction, intussusceptions or bleeding.1,2 However, dysphagia caused by Tin(IV) mesoporphyrin IX dichloride gastric KS as the presenting symptom of AIDS is exceptional. CASE PRESENTATION A 60-year-old man was admitted to the Gastroenterology unit of our hospital with a 2-month history of persistent dysphagia for liquid and solid foods. The patient smoked 10 cigarettes a day, drank moderate quantities of alcohol and his medical history was unremarkable. Oesophagogastroduodenoscopy revealed pseudomembranes throughout the length of the oesophagus and two ulcerative lesions with thickened borders in the gastric body and antrum (fig 1). Multiple biopsy samples were taken around the distal oesophagus and on the borders of the gastric ulcers. Histological analysis at that time revealed mycotic oesophagitis and acute gastritis with ulceration. After medical therapy with a proton pump inhibitor and itraconazole, the patient showed improvement but no disappearance of the symptoms. Clinical evaluation ruled out diabetes mellitus and the use of immunosuppressive drugs. A repeat endoscopy showed no macroscopic changes of the gastric ulcers, and further biopsy samples were obtained from the base and ulcer margins. Histopathologically, the lesions consisted of spindle cell and capillary sized vascular proliferation (fig 2). These findings were consistent with KS of the stomach. Open in a separate window Physique 1 Endoscopic image of ulcerative lesion in the gastric antrum. The gross appearance shows the haemorrhagic central area surrounded by thickened mucosal borders. Open in a separate window Physique 2 Kaposi sarcoma of the stomach. The tumour is composed of spindle-shaped cells, forming slit-like spaces with infiltration between glands accompanied by a variably mixed mononuclear inflammatory cell infiltrate. EE, extravasated erythrocytes. The patient was subsequently tested for HIV contamination and found Tin(IV) mesoporphyrin IX dichloride to be positive. INVESTIGATIONS Sections (3 m) from buffered, formalin fixed, paraffin embedded tissues were created and stained with H&E. Perls and periodic acidCSchiff (PAS) stainings were also performed. Immunohistochemical studies were performed Tin(IV) mesoporphyrin IX dichloride using the avidin-biotin-peroxidase system (ABComplex, Dako, Glostrup, Denmark). The reagents are listed in table 1. Table 1 Antibodies for immunohistochemical study

AntibodiesCloneSupplierDilution

CD34QBEnd/10Lab Vision CorporationReady to useActin easy muscle1A4Lab Vision Corporation1:100S100PolyclonalDakoReady to useCD117PolyclonalDako1:40HHV8-LNA113B10Novo Castra1:25Fli-1PolyclonalLab Vision Corporation1/20D2-40D2-40Signet1:40 Open in a separate window Fli-1, Friend leukaemia virus integration 1; HHV8, human herpesvirus 8; LNA1, latent nuclear antigen 1. The histological picture of the oesophageal mucosa showed a severe oesophagitis with numerous yeast and pseudohyphal fungal forms that were positive on PAS staining. The gastric lesions of the first sample showed chronic gastritis with an exudative component. In the gastric specimens of repeat endoscopy both ulcerative lesions consisted of spindle cell proliferation (fig 2) with slit formation and markedly dilated capillary proliferation accompanied by extensive red blood cell extravasation and moderate lymphocytic and plasma cell infiltrate with deposition of brown haemosiderin-like pigment (fig 3). Infiltration of the gastric glands by spindle cells was observed. Some tumour cells presented PAS-positive (fig 4) hyaline globules. On immunohistochemistry, the tumour tested positive for CD34 (fig 5), factor VIII, D2-40, Friend leukaemia virus integration 1 (Fli-1) and latent nuclear antigen 1 (LNA1) (fig 6), and unfavorable for S100 and easy muscle actin. Open in Tin(IV) mesoporphyrin IX dichloride a separate window Physique 3 The spindle cells in some areas with the appeared of fibroblasts packed Rabbit Polyclonal to TAF1 the lamina propria. The nuclei are elongated and plump. Note the extravasated erythrocytes (EE) within the neoplastic cells. Open in a separate window Physique 4 Some neoplastic cells showed periodic acidCSchiff (PAS) positive hyaline globules intracytoplasmatically. Open in a separate window Physique 5 The lesional cells display immunoreactivity for the CD34. The glandular cells are unfavorable (arrow) (DAB). Open in a separate window Physique 6 Immunohistochemistry. All tumour cells display strong nuclear immunoreactivity for human herpesvirus 8 (HHV8)-latent nuclear antigen 1 (LNA1) antibody (DAB). DIFFERENTIAL DIAGNOSIS On clinical grounds KS of Tin(IV) mesoporphyrin IX dichloride the stomach has to be differentiated from.